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A number of lifestyle and environmental factors can trigger a rosacea flare-up, including your diet. Although rosacea affects your skin, what you eat can play a big role in managing your symptoms, according to Robynne Chutkan, MD, a gastroenterologist and assistant professor in the division of gastroenterology at Georgetown University Hospital in Washington, D.C., and author of the book Gutbliss.

"The relationship between the gut and the skin is fascinating, and rosacea is a prime example of how they interact," explained Dr. Chutkan. "As a rosacea sufferer myself, I'm particularly interested in this."

Dr. Robynne Chutkan: Questions and Answers on Eating Right With Rosacea

Although factors that cause rosacea to flare up vary from person to person, in the following question-and-answer session, Chutkan shed some light on the link between diet and rosacea. She also provided rosacea diet tips that may help keep your symptoms in check.

Q: What's the thinking behind eating right with rosacea?

"The gut is a hollow tube that runs the length of the body, from the mouth to the anus, so think of the digestive tract as the inside of the skin," Chutkan said. "It's helpful to think that way. Really, the two are very connected. I'm not the first, and I'm sure I won't be the last, to comment on that observation."

A bacterial imbalance in the gut can show up on the skin and worsen conditions like rosacea, she added. "For those with bloating and GI upset who also have rosacea, there is a clear correlation between bacterial overgrowth and this skin condition," she explained. Certain foods, frequent antibiotics, steroids, and antacids are among the factors that can upset the delicate balance of bacteria in the gut and lead to an overgrowth of bad bacteria and a shortage of the good bacteria. Chutkan explained that identifying the cause of a bacterial imbalance is key to improving rosacea symptoms.

Q: Does recent research suggest a link between the gut and rosacea?

"A 2008 controlled study conducted by researchers in Genoa, Italy, looked at 120 patients from a dermatology clinic with rosacea and 60 people that didn't have it," Chutkan said. "They found that a significant percentage of the rosacea patients had small intestinal bacterial overgrowth, or SIBO. There was a higher prevalence of this bacterial overgrowth among the rosacea patients than in the control group as well as the general population."

The researchers treated the patients with the bacterial imbalance with antibiotics. They found that by eradicating the overgrowth of bad bacteria, about 70 percent of the rosacea patients' skin cleared up entirely, and over 20 percent experienced a dramatic improvement in their symptoms. Moreover, the rosacea patients who were given a placebo pill and saw no improvement in their rosacea symptoms were later given the antibiotic, and, after taking the drug, they also experienced a dramatic improvement in their symptoms. The study, published in Clinical Gastroenterology and Hepatology, also revealed that after nine months of follow-up, 96 percent of the rosacea patients remained in remission.

Q: What are some common food triggers that can cause rosacea to flare-up?

"Alcohol seems to be a universal trigger for people with rosacea," Chutkan said. "Some people find dairy worsens their symptoms. Others say soy or artificial sweeteners trigger a flare-up. Caffeine also affects some people."

Chutkan's advice is two-fold. "It's a good idea to avoid things that kill off good bacteria like antacids [because], if you block stomach acids, you get overgrowth of bacteria in the digestive tract. You should also avoid the starchy and sugary foods that encourage the overgrowth of bad bacteria species."

Q: What foods should I eat to help control my rosacea?

Leafy greens and other high-fiber foods, such as lentils, asparagus, and kale, can help create an environment in the gut that allows good bacteria to grow, Chutkan pointed out. "We are talking about cutting out cake and ice cream and making changes that will have other health benefits," she said. "There are also some probiotics that are useful, but it's more about diet and eating the kind of food that will encourage the growth of good bacteria and discourage the growth of bad bacteria."

Q: Is there a specific rosacea diet?

Although there's no specific rosacea diet, Chutkan noted that two diets limit starches and other foods that may lead to the overgrowth of harmful bacteria in the gut. "I looked at what was written in medical literature about the anti-inflammatory diet for skin," she said. "This diet excludes refined sugar, complex carbohydrates, and high levels of saturated fat. It encourages nutrient-dense foods, such as deeply pigmented fruits and vegetables. It also encourages eating good sources of omega-3 fatty acids, such as wild salmon and chia flax seeds."

Another diet that may promote a healthy balance of bacteria in the gut is the Paleolithic or Paleo diet, added Chutkan. "It's an early low-carb diet, in which people eat as cavemen or women did before the advent of fire," she said. "You cut out sugar and processed grain and eat unlimited amounts of animal protein, fruits and vegetables, nuts, and seeds. You avoid peanuts and other legumes as well as dairy of any kind." Chutkan noted the Paleo diet is popular among endurance athletes. "If you look at a lot of chatter in those communities, it's all about how this diet improves acne, rosacea, and joint pain. My patients do very well on it from a digestive point of view, and very frequently their skin clears up."

Q: Why do hot liquids seem to make symptoms worse?

The facial blood vessels of people with rosacea may dilate too easily. This increased blood flow near the skin surface can make the skin look red and flushed. "Extreme temperatures do not cause rosacea, but this can make the condition worse by dilating the blood vessels and increasing blood flow even more, so the skin appears even more red," Chutkan explained.

"Citrus fruits release histamine, which can aggravate rosacea; spicy foods aggravate rosacea by causing dilation of the tiny blood vessels under the skin," Chutkan said. "It's important to remember, however, that rosacea triggers are different for everyone, and if spicy foods or citrus fruits don't cause worsening of your condition, there is no need to avoid or eliminate them."

Q: After making dietary changes, how soon can I expect to see an improvement in my rosacea symptoms?

"What I tell my patients is that they didn't develop this condition overnight -- they developed it over their lifetime," Chutkan said. "There must be a shift in the bacteria in the gut towards more beneficial species and less of the not-so-good species. You can't cure rosacea overnight, but over a period of several weeks, you can really see improvements."

Her suggestion: "Start a 10-day or two-week plan for rosacea where you eliminate possible triggers from your diet and see if things get better. In some cases, improvements can be seen in as little as 10 days, but that might not be typical. At the end of six weeks with no difference, maybe diet doesn't play a big role for you. But things can continue to improve for up to six months."

Q: What about craving foods that have been eliminated from the diet?

"If things do clear up after making healthy dietary changes, and you find that you are really missing something, you can reintroduce it and see how you react," Chutkan said. "It's important to do this with one food at a time in order to evaluate your body's response."

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